Provider Escalation & Resolution Specialist

Zelis Healthcare, LLC; Atlanta (GA); Hybrid; USD 19,000 - 25,000; Full time

Job summary

Zelis, a leading healthcare payments company, invites you to join as a Provider Escalation & Resolution Specialist to deliver exceptional client service, address inquiries, and partner with internal teams to resolve issues. The role requires 1+ year of customer service experience, healthcare familiarity preferred, and a solid understanding of Zelis products.

This is a hybrid US-based position; visa sponsorship is not available at this time.

Qualifications

• 1+ yrs customer service experience.
• Healthcare experience helpful.
• Experience working with healthcare escalation tickets is preferred.
• Troubleshoot ticket-related issues and provide timely and effective resolutions preferred.
• Requires proficiency using AI tools skillfully with an understanding of how to develop/create intelligent prompts and/or agents.
• Excellent written and verbal communication skills.
• Strong problem-solving and conflict resolution skills.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite and customer relationship management (CRM) software.

Responsibilities

• Respond to client inquiries via phone, email, and in-person meetings in a timely and professional manner.
• Provide accurate information and assistance to clients regarding products, services, and policies. Requires knowledge of the Zelis products and services.
• Resolve client issues and complaints efficiently, ensuring client satisfaction and retention.
• Manage client accounts, ensuring all client information is up-to-date and accurate.
• Conduct regular check-ins with clients to assess their needs and satisfaction levels.
• Investigate and resolve client issues by coordinating with internal departments.
• Escalate complex issues to higher-level support or management as needed.
• Follow up with clients to ensure their issues are resolved and they are satisfied with the service.
• Maintain detailed and accurate records of client interactions and transactions.
• Prepare and submit regular reports on client inquiries, issues, and resolutions.
• Identify trends in client issues and provide feedback to improve processes and services.
• Stay updated on company products, services, and policies.
• Provide clients with information on new products and services that may meet their needs.
• Participate in team meetings and contribute to the development of client service strategies and high-quality client service experience.
• Support other team members during peak times or when additional help is needed.

Skills

Customer service

Healthcare experience

Ticket escalation experience

AI tooling prompts

Communication skills

Problem solving

Teamwork

MS Office

CRM software

Tools

CRM software

Microsoft Office Suite

Job description

At Zelis, we Get Stuff Done. So, let's get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

A Little About You

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

The Provider Escalation & Resolution Specialist will be responsible for providing exceptional customer service and support to clients. This role involves addressing client inquiries, resolving issues, and ensuring a positive client experience.

The Provider Escalation & Resolution Specialist will serve as the first point of contact for clients and will work closely with other team members to deliver high-quality service.

What You'll Do:

• Respond to client inquiries via phone, email, and in-person meetings in a timely and professional manner.
• Provide accurate information and assistance to clients regarding products, services, and policies. Requires knowledge of the Zelis products and services.
• Resolve client issues and complaints efficiently, ensuring client satisfaction and retention.
• Manage client accounts, ensuring all client information is up-to-date and accurate.
• Conduct regular check-ins with clients to assess their needs and satisfaction levels.
• Investigate and resolve client issues by coordinating with internal departments.
• Escalate complex issues to higher-level support or management as needed.
• Follow up with clients to ensure their issues are resolved and they are satisfied with the service.
• Maintain detailed and accurate records of client interactions and transactions.
• Prepare and submit regular reports on client inquiries, issues, and resolutions.
• Identify trends in client issues and provide feedback to improve processes and services.
• Stay updated on company products, services, and policies.
• Provide clients with information on new products and services that may meet their needs.
• Participate in team meetings and contribute to the development of client service strategies and high-quality client service experience.
• Support other team members during peak times or when additional help is needed.

What You'll Bring to Zelis:

• 1+ yrs customer service experience.
• Healthcare experience helpful.
• Experience working with healthcare escalation tickets is preferred.
• Troubleshoot ticket-related issues and provide timely and effective resolutions preferred.
• Requires proficiency using AI tools skillfully with an understanding of how to develop/create intelligent prompts and/or agents.
• Excellent written and verbal communication skills.
• Strong problem-solving and conflict resolution skills.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite and customer relationship management (CRM) software.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

$14.00 - $18.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [e-mail].

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.